Antibiotics versus no antibiotic therapy for uncomplicated sigmoid diverticulitis: a meta-analysis

Willmar Jayve  M. Añoso,; Omar  O. Ocampo,

Antibiotics versus no antibiotic therapy for uncomplicated sigmoid diverticulitis: a meta-analysis

Abstract:

Introduction Antibiotics have been used customarily in the treatment of uncomplicated diverticulitis since their introduction and have become the standard of care. The aim of this study is to compare the effectiveness of antibiotic therapy versus no antibiotic therapy in the treatment of uncomplicated sigmoid diverticulitis. Methods An electronic search for randomized controlled trials comparing antibiotics versus no antibiotic therapy for uncomplicated diverticulitis was conducted. The outcomes considered were associated morbidity (abscess formation and sigmoid perforation); need for sigmoid colon resection, and recurrence of diverticulitis. The included studies were evaluated for risk of bias. Meta-analysis with Forest plot was performed using Review Manager Version 5.3. Results Two trials, consisting of 1,151 subjects, were included in the meta-analysis. There was no difference in the risk of sigmoid perforation (RR 1.02, 95% CI 0.30, 3.49). Abscess formation and incidence of sigmoid resection were lower in the antibiotics groups (RR 2.24, 95 CI 0.51, 9.95 and RR 1.59, 95% CI 0.75, 3.36, respectively) but the differences were not significant. There was no difference in the recurrence of diverticulitis (RR 1.05, 95% CI 0.74, 1.48) between the two groups. Conclusion There is no definite advantage in giving antibiotics to patients with uncomplicated diverticulitis. Not giving antibiotics may be an acceptable treatment option for patients with acute uncomplicated sigmoid diverticulitis.

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